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Surgeons underestimate domestic violence

In North America, domestic violence is the most common form of nonfatal injury to women. More than 40 percent of women have reported experiencing one or more forms of violence, and 35 percent have experienced intimate partner violence (IPV), commonly referred to as domestic violence.

Yet despite these disturbingly high numbers, orthopaedic surgeons seem to “grossly underestimate” the prevalence of IPV in their practices and harbor several misperceptions about battered women, reported Gregory J. Della Rocca, MD, PhD, FACS, on Thursday.

Dr. Della Rocca, of the department of orthopaedic surgery at the University of Missouri, and colleagues conducted a Web-based survey of members of the Orthopaedic Trauma Association (OTA). The survey covered the following aspects of the IPV issue:

  • the perception of surgeons regarding the identification of IPV victims in orthopaedic clinics
  • attitudes and beliefs of surgeons regarding IPV victims and their batterers as well as factors that increase or decrease the likelihood of violence
  • presentation attributes of patients in trauma clinics that might lead to suspicion of IPV, and the need for written guidelines for the detection and management of IPV in orthopaedic clinics.

Of the 690 active OTA members at the time of the survey (summer 2009), 153 (22 percent) responded. Of these, 90 percent were male, and all but 4 were aged 30 to 60 years.

Respondents estimated that IPV prevalence in their practices was very low—1 percent or less of female patients. Although respondents estimated the prevalence in their communities to be higher—nearly half responded that IPV was “somewhat common,” affecting 5 percent of all women—the authors say “this is likely a gross misperception.”

Respondents identified the following barriers that limit them in assessing for IPV: time constraints (40 percent), lack of knowledge of what to ask (60 percent), lack of knowledge of what to do if a patient does say she is an IPV victim (53 percent), and lack of knowledge of the community resources available to victims (60 percent).

Although 38 percent of surgeons said they thought that physicians’ personal discomfort with assessing patients represented a barrier, 23 percent said they themselves were either uncomfortable (22 percent) or very uncomfortable (1 percent) with asking a female patient if she had been abused. Most respondents (74 percent) did agree that identifying IPV victims was relevant to their practice, and more than half (51 percent) disagreed that assessing patients for IPV is a low-priority issue.

Misconceptions
Questions about attitudes and perceptions regarding the victims of IPVs revealed several key misconceptions, Dr. Della Rocca said. For example, 16 percent of respondents agreed that “the victim must be getting something out of the abusive relationship” and 20 percent agreed that “some women have personalities that cause the abuse.”Additionally, 5 percent said they thought IPV victims choose to be victims, 5 percent agreed that the victim does something that brings about the violence, and 7 percent responded that both the victim and the batterer are responsible for the abuse (ie, “it takes two to tango”).

Most respondents (71 percent) disagreed with the notion that they could do little to help because the victim is unlikely to leave the abusive relationship. But Dr. Della Rocca was surprised to find that 20 percent of respondents thought that asking nonabused patients about IPV would anger them.

Surveyed physicians also had misperceptions about batterers. Asked if patients would be offended if asked about the possibility that they exhibited abusive behavior, 40 percent answered yes. One out of four said that batterers would direct their anger toward the healthcare provider if challenged, and a similar number said there was insufficient security at the workplace to permit a proving discussion with batterers.

Knowledge gap?
Just more than half (53 percent) of respondents said they were unsure whether reporting of IPV was required in their jurisdiction, and only 23 percent had ever attended an educational or training session on IPV. Very few (8 percent) are at clinics with written guidelines for detection or management of IPV, and a majority (72 percent) said that information provided about signs and indicators of IPV would be helpful—although only 49 percent stated that they would like to receive training on identifying IPV.

He concluded that “Targeted educational programs to orthopaedic surgeons involved in the routine care of patients with musculo-skeletal injuries might be beneficial to improve the care delivered to female victims of intimate partner violence.”

The coauthors of “Orthopaedic Surgeons’ Knowledge and Attitudes in the Clinical Identification of Intimate Partner Violence Against Women” are Sheila Sprague, MSc; Sonia Dosanjh, MSW; Emil H. Schemitsch, MD, FRCS(C); and Mohit Bhandari, MD, PhD, FRCS(C).

Disclosure information: Dr. Della Rocca—Amedica, Synthes, Smith & Nephew, Stryker, Wound Care Technologies; Ms. Sprague—Amgen; Ms. Dosanjh—no conflicts; Dr. Schemitsch—Stryker, Amgen, Pfizer, Synthes, Smith & Nephew, Baxter, Wright Medical Technology, Brainlab, Omega, Elsevier; Dr. Bhandari—Amgen, Eli Lilly, Pfizer, Stryker, Smith & Nephew.

Prepared by Terry Stanton, senior science writer for AAOS Now.

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